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General NPI Number Information
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NPI Number | 1235496027
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Entity Type | Individual
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Provider Name | SHEENA LONG PT, DPT, ATC
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Gender | Female
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Dates
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Enumeration Date | 04/18/2012
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Last Update Date | 08/05/2020
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Provider Practice Location Address
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Address Line | 4860 WASHTENAW AVE STE A
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City | ANN ARBOR
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State | MI
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Zip | 48108-3401
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Country | US
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Telephone | 734-489-7995
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Fax | 734-800-2155
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Provider Business Mailing Address
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Address Line | 600 OAKMONT LN STE 600C
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City | WESTMONT
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State | IL
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Zip | 60559-5548
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Country | US
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Telephone | 630-575-6250
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Fax | 630-575-7450
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 070-019024
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 2251S0007X
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Taxonomy Name | Sports Physical Therapist
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License Number | PT016642
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 5501017835
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License Number State | MI
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